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New Compliance Updates. BuildMyHealth’s ‘Guide to Survive.’ Running Your Medical Practice in 2023

no surprises act

What is the No Surprises Act

The No Surprises Act (NSA) went in to effect January 1st 2022. For those unfamiliar… the No Surprises act is an effort to reduce the number of surprise bills that patients are faced with after their procedure. Even after a year of implementation the Act is still largely overlooked by most medical offices, providers, and most importantly patients. It requires a level of price transparency for both insurance and self-pay healthcare services that will affect Americans and the medical establishment far more than previous price transparency rules imposed on hospitals and insurance companies. As both sides become more familiar with the No Surprises Act it will absolutely change the economics of healthcare and allow patients to get more information regarding their medical care than ever before.

How does the NSA apply to Aesthetics

While the No Surprises Act is typically related to insurance-covered medical treatments, the same rules apply to patients for both medically necessary and aesthetic services. Part of the No Surprises Act as it relates to aesthetics is a patient’s right to a Good Faith Estimate (GFE). Essentially what this means is that if a patient is looking to do a procedure that requires multiple providers (surgeon, anesthesiologist, surgical facility) or a treatment or service that requires multiple sessions (laser hair removal, counseling, physical therapy), then they are entitled to all of the reasonably expected costs associated with that procedure or service. For example if a patient is enquiring about a breast augmentation or knee replacement, not only are they entitled to the surgeon’s fee associated with the breast augmentation or knee replacement, but also all of the other ancillary fees, such as anesthesia, OR and implant fees. While most practices are not quick to share pricing due to high number of price shoppers these new laws should be looked at as an opportunity and not a burden!

How to Comply with No Surprises Act

Compliance can be an overwhelming thought often paired with a fear of consequences for being non compliant. Even the smallest infraction can result in the biggest punishment ($10,000 for each violation of the NSA) so it is important to make sure you do everything you can to play by the rules. When it comes to the No Surprises Act, the best course of action is to operate in good faith and provide accurate data to all of your patients both new and existing. The easiest way to stay in compliance with the No Surprises Act is just how it sounds. Don’t surprise your patients with any bills after their procedure. If you think there may be some unexpected charges after the procedure (ie longer time in the OR), then provide those estimates ahead of time. Because remember, the law doesn’t say you can’t send a bill after a procedure. The goal is to avoid a surprise bill after a procedure. So if you know there may be pathology or lab work involved, include that in your preop estimate.

Simple Ways to Comply with the NSA

Establish Pricing

The first thing you need to do is establish pricing in an easy to follow fee schedule and share that with your staff. If you want to be high end be high end and if you want to focus on volume, offer the lowest prices in town but either way you need to have established pricing. If you’re unsure if you have established pricing, sit down with each member in your practice and ask them if they know the pricing. Once you have established pricing in your practice it will help the compliance aspect, because as the business owner, you know that no matter who talks to the potential patient they will receive the same information. If you have two people speaking with potential patients and providing different information, that could result in non compliance. To make it easy to determine pricing, you can create a free account at buildmybod.com/providers. Here you can compare prices to providers both in and around your area and on a national scale to help determine where you fit within the competitive landscape. This will also help you establish accurate prices reflective of your current business goals.

Implement Quoting protocols within your practice

Once you have established pricing in your practice, the next step is implementing protocols for your staff to easily share with potential patients. The one thing that every patient has in common is that in order for them to move forward with becoming a patient they need to know how much that treatment costs. The No Surprises Act forces us to share this information with patients in the form of that GFE outlining all of the potential costs. BuildMyHealth’s software program helps with creating these Good Faith Estimates to ensure you are in Compliance with NSA from the beginning.

Document Potential Patient Interactions

If you are going to be a successful practice when it comes to following the guidelines set out by the No Surprises Act as well as one that that reaches all of your revenue goals in 2023, you are going to have to create a number of Good Faith Estimates. This means there will be a number of potential patients receiving pricing information. Providers are very used to documenting a medical history, but you also need to make sure you are documenting each and every financial interaction as well. It only takes one misstep to fall out of compliance with the No Surprises Act. BuildMyHealth’s back end makes it easy to record all of your quotes and good faith estimates so that you can accurately track all of your financial conversations and ensure that each patient is receiving the most accurate information. And if they aren’t, it gives you the opportunity to make sure that they do.

Automate NSA compliance with Software

One of the biggest challenges that medical offices are faced with due to the No Surprises Act is the amount of time required generating a GFE. This undeniably takes time away from other things that contribute to the success of the practice. However if you follow the guide provided and take the steps to establish pricing, you can speed this process up exponentially so that your staff member doesn’t need to create good faith estimates on the fly.

BuildMyHealth shifts some of the quote creation process to the patient. By allowing them to create an estimate through a price estimator or chatbot on the provider’s website, the consumer can start the process. That estimate does not constitute a GFE. But if the patient comes in for a consultation, the office staff can take that estimate, update as needed and convert into a NSA-compliant GFE much faster than if the staff had to create the estimate from scratch.

The Benefits to NSA compliance

Outside of the obvious answer that compliance with the No Surprises Act avoids non-compliance, there are a number of other benefits in complying with the NSA. If we assume that every qualified potential patient we interact with receives a GFEv and we do a good job tracking our good faith estimates, we can keep track of important financial information. Generally speaking, medical offices can track data in either their EHR or accounting software to keep track of revenues. But how do we track and make projections based on the potential revenue? Complying with the No Surprises Act allows you to see the amount of potential revenue in your practice compared with the actual revenue coming in to the practice. Knowing this information gives the ability to make marketing decisions, hiring decisions as well as understanding our conversion rates as it relates to tracking ROI from marketing efforts.

Is your Marketing NSA Compliant

The truth is, there is no requirement when it comes to incorporating pricing information into your marketing efforts. But does that mean it isn’t smart to do so?! Do you want to see more patients and get more revenue in 2023? The one thing standing between you and every potential patient coming in to the practice is pricing. Now that you have established pricing, trained your staff to talk about pricing, and implemented software to make it easy to track, the only thing left is to tell your patients! Generally speaking, it’s not the best idea to list a menu of services with prices. But that doesn’t mean you can’t share pricing information in a way that benefits to your practice. BuildMyHealth’s use of a price estimator and chatbot to capture contact information means the practice can collect a name, phone number and verified email address to passively grow an email database for future email marketing. From there, all of the steps to comply with the NSA can be automated.

Learn more about BuildMyHealth’s NSA compliant Software Today

 

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